Promoting nutrition in older people in nursing and residential homes

Malnutrition and dehydration are serious and common problems among older people in nursing and residential care homes. The situation is exacerbated because staff may not be trained to recognize the signs and symptoms of malnutrition and dehydration and hence opportunities for early intervention are missed. A nutrition assessment should form part of the admission process to identify whether an individual has, or is at risk of developing, malnutrition and dehydration. This article suggests key questions that should be asked to assist this process. The individual and organizational risk factors that affect nutrition and health status are discussed, and practical suggestions given to help address any problems recognized. The causes and consequences of dehydration are explained and practices that place an individual at risk of dehydration considered. Suggestions are given to help identify when a person is not drinking sufficiently so that early rapid intervention can be initiated. Helping an older person to eat and drink independently is a practical activity that is often undervalued. Its importance needs to be recognized in all nursing and residential care settings.

The starving patient: supportive care for people with cancer

Unintentional weight loss in people with cancer is associated with decreased quality of life and increased mortality. Addressing risk factors that lead to weight loss may improve quality of life and prevent cachexia. Specific, individualized counseling is the most beneficial and economic intervention for nutritional health. Appetite stimulants promote oral intake, and oral supplements help to meet the increased need for calories and protein during the course of the disease and its treatment. Utilizing the gut for digestion and absorption of food maintains the critical functions of the bowel lumen. Tube feeding and parenteral nutrition may be indicated for prevention of malnutrition in some disease conditions and during certain types of cancer treatment.

Nutrition support in cancer

OBJECTIVES

To describe nutrition intervention strategies frequently used to support cancer patients experiencing malnutrition.

DATA SOURCES

Textbook chapters, database reports, and current related literature.

CONCLUSIONS

Clinicians have many options for providing nutrition support interventions for the cancer patient at risk for malnutrition. The most appropriate strategy for a patient should be based on a careful assessment of contributing factors with input from a multidisciplinary team.

IMPLICATIONS FOR NURSING PRACTICE

It is important for nurses to be knowledgeable about nutrition intervention options available to patients at various points along the cancer trajectory. Oncology nurses are in a key position to provide support to patients and families with regard to nutrition issues. Of paramount importance is their contribution to ongoing assessment of nutritional status and early and aggressive intervention to meet nutritional needs.

Nutritional issues in patients with severe neutropenia

OBJECTIVES

To provide information on the assessment and management of the nutritional needs of patients with severe neutropenia.

DATA SOURCES

Textbook chapters, research articles, and review articles.

CONCLUSIONS

Malnutrition is a common result of high-dose chemotherapy treatment. Clinical outcomes are directly related to careful assessment, early intervention, and ongoing evaluation and monitoring in the severely neutropenic population.

IMPLICATIONS FOR NURSING PRACTICE

Early assessment, management, and psychological support are essential in meeting the needs of this patient population.

Nutritional considerations in pediatric oncology

OBJECTIVES

To summarize the characteristics of a nutrition care plan for pediatric patients, specifically pediatric screening, assessment, and treatment protocols.

DATA SOURCES

Review articles, manuals, and textbooks.

CONCLUSIONS

Nutritional support of pediatric patients with cancer differs from adults because of their unique nutritional needs, their wide age range (infants to adolescents), and the psychosocial aspects of treating the entire family.

IMPLICATIONS FOR NURSING PRACTICE

To participate in the prevention and treatment of malnutrition in the pediatric patient with cancer, nurses require an understanding of nutrition care in this specialized population.

Nutritional screening and assessment

OBJECTIVES

To review the components of nutritional screening, screening measures and tools, and the nurses' role in nutritional assessment.

DATA SOURCES

Research studies, review articles, and book chapters.

CONCLUSIONS

Timely and appropriate nutritional interventions require the adoption of routine initial nutritional screening, referral for comprehensive nutritional assessments as needed, and continued re-screening.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses should be prepared to contribute to a comprehensive nutritional assessment in their role as patient advocate and expert clinician.

Symptoms and their impact on nutrition

OBJECTIVES

To provide assessment guidelines and management strategies for symptoms affecting nutritional status in patients with cancer.

DATA SOURCES

Published articles, book chapters, and research reports.

CONCLUSIONS

Patients with cancer experience a variety of symptoms that affect their nutritional status. It is possible to reduce the impact of these symptoms on the nutritional status of the patient through effective symptom management strategies, nutritional assessments, and interventions.

IMPLICATIONS FOR NURSING PRACTICE

The nutritional status of cancer patients can be supported by anticipating and managing disease- and treatment-related symptoms. Nurses contribute actively to the achievement of positive patient outcomes when they manage symptoms in a manner that enhances nutrition.

Optimizing nutrition for patients with cancer

Malnutrition is the most common secondary diagnosis in patients with cancer and is a major prognostic indicator for poor response to cancer therapy and shortened survival. The word CANCER can be used as an acronym to guide early nutritional intervention that combines an understanding of cancer cachexia with a plan to optimize patients' nutritional status during the stress imposed by cancer and its treatment. Conversations with patients reveal nutrition-related information that is valuable as part of a comprehensive assessment. The Assessment combines nutrition-related information with observations made during the conversation. The Nutrition plan is developed to meet patients' identified nutritional needs. The goals of the cancer treatment dictate the aggressiveness of nutritional support. An awareness of potentially life-threatening Complications of enteral and parenteral nutrition is essential. An ongoing Evaluation of patients' status and responses to the nutrition plan guides changes to the plan as needed. Reassurance/Removal are important parts of care during all stages of treatment and nutrition support.

Is altered nutritional status the root cause of your clients' negative outcomes?

The impact of altered nutritional status is costly. Surgical patients have 2-3 times the risk of complications, length of stay is extended by 90%, and charges are 35-75% higher. Risk factors are numerous; therefore, collaboration among all members of the health care team is required to impact patient outcomes positively. The purpose of this article is to review the significance of alteration in nutrition and its impact on patient outcomes. The article demonstrates two approaches to improve the quality of care given to clients with an identified alteration in nutritional status: a clinical research project and a quality improvement project.

A critical evaluation of the use of nutrition screening tools by nurses

Malnutrition remains a problem in hospital and community patients, the consequences of which have deleterious effects on the sick individual and cost implications for healthcare providers. Provision of nutritional support has been shown to improve patient outcome in those at risk of malnutrition; therefore, the detection and treatment of malnutrition is paramount. Nurses have been identified as being in an ideal position to carry out routine nutritional screening to detect patients at risk of malnutrition and hence refer to the dietitian for detailed nutritional assessment and provision of nutritional support. Therefore, many nutritional screening tools have been developed to guide nurses in basic nutritional screening. However, for a tool to be effective certain criteria must be met including ease of use, cost-effectiveness, the presence of an action plan and prior testing for validity, reliability, sensitivity and specificity. Six such tools are critically evaluated in this article to establish whether they meet these criteria. Surprisingly, none of the screening tools demonstrated a beneficial effect on clinical outcome or met all of the above criteria. It is therefore essential that these tools are refined and retested before becoming part of established nursing practice.

Choosing nutrition support: how and when to initiate

Surveys have shown that malnutrition is present in approximately 50% of all hospitalized patients. With the continued reduction in length of stay in acute care facilities, it is critical that ALL patients receive a nutrition screen and, when appropriate, a comprehensive nutritional assessment. Once the nutrition evaluation has been completed, the next step is to determine the most appropriate route of nutrition intervention. This article provides some guidelines that can be used to determine the type of nutritional support to be implemented. It also contains information on access routes, benefits, and complications with interventions for both enteral tube feeding and parenteral nutrition.

Meeting the nutritional needs of people with mental health problems

In these days of holistic care, it is perhaps surprising that the nutritional needs of people with mental health problems may still be overlooked. Alison Sullivan and Rick Tucker describe the role of the nurse in this neglected area of care.